Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure

Presciutti, Steven M.; Karukanda, Teja; Lee, Mark

doi:10.1016/j.spinee.2013.11.055

Cited by 78 publications

(59 citation statements)

References 11 publications

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“…In addition, radiographic diagnostics in childhood has been shown to contribute significantly to leukemia and prostate cancer [ 14 ]. A recent study reported that the management decisions, which are made mainly based on Cobb angle, for AIS significantly affect patient radiation exposure, and it was therefore suggested that research for new imaging modalities with limited ionizing radiation should be undertaken [ 15 ]. Efforts have been made to reduce the radiation dose for scoliosis evaluation by using scanning radiography imaging [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

A reliability and validity study for Scolioscan: a radiation-free scoliosis assessment system using 3D ultrasound imaging

et al. 2016

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BackgroundRadiographic evaluation for patients with scoliosis using Cobb method is the current gold standard, but radiography has radiation hazards. Several groups have recently demonstrated the feasibility of using 3D ultrasound for the evaluation of scoliosis. Ultrasound imaging is radiation-free, comparatively more accessible, and inexpensive. However, a reliable and valid 3D ultrasound system ready for clinical scoliosis assessment has not yet been reported. Scolioscan is a newly developed system targeted for scoliosis assessment in clinics by using coronal images of spine generated by a 3D ultrasound volume projection imaging method. The aim of this study is to test the reliability of spine deformity measurement of Scolioscan and its validity compared to the gold standard Cobb angle measurements from radiography in adolescent idiopathic scoliosis (AIS) patients.MethodsProspective study divided into two stages: 1) Investigation of intra- and inter- reliability between two operators for acquiring images using Scolioscan and among three raters for measuring spinal curves from those images; 2) Correlation between the Cobb angle obtained from radiography by a medical doctor and the spine curve angle obtained using Scolioscan (Scolioscan angle). The raters for ultrasound images and the doctors for evaluating radiographic images were mutually blinded. The two stages of tests involved 20 (80 % females, total of 26 angles, age of 16.4 ± 2.7 years, and Cobb angle of 27.6 ± 11.8°) and 49 (69 % female, 73 angles, 15.8 ± 2.7 years and 24.8 ± 9.7°) AIS patients, respectively. Intra-class correlation coefficients (ICC) and Bland-Altman plots and root-mean-square differences (RMS) were employed to determine correlations, which interpreted based on defined criteria.ResultsWe demonstrated a very good intra-rater and intra-operator reliability for Scolioscan angle measurement with ICC larger than 0.94 and 0.88, respectively. Very good inter-rater and inter-operator reliability was also demonstrated, with both ICC larger than 0.87. For the thoracic deformity measurement, the RMS were 2.5 and 3.3° in the intra- and inter-operator tests, and 1.5 and 3.6° in the intra- and inter-rater tests, respectively. The RMS differences were 3.1, 3.1, 1.6, 3.7° in the intra- and inter-operator and intra- and inter-rater tests, respectively, for the lumbar angle measurement. Moderate to strong correlations (R2 > 0.72) were observed between the Scolioscan angles and Cobb angles for both the thoracic and lumbar regions. It was noted that the Scolioscan angle slightly underestimated the spinal deformity in comparison with Cobb angle, and an overall regression equation y = 1.1797x (R2 = 0.76) could be used to translate the Scolioscan angle (x) to Cobb angle (y) for this group of patients. The RMS difference between Scolioscan angle and Cobb angle was 4.7 and 6.2°, with and without the correlation using the overall regression equation.ConclusionsWe showed that Scolioscan is reliable for measuring coronal deformity for patients with AIS and appears ...

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Section: Introductionmentioning

confidence: 99%

A reliability and validity study for Scolioscan: a radiation-free scoliosis assessment system using 3D ultrasound imaging

et al. 2016

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“…Patients are also negatively affected by increased exposure. Compared with surgeons, they experience much higher doses of intraoperative radiation, which in some populations elevates the lifetime risk of solid malignancies 1.4-2.4% [21]. This increase is due to the patients' unmodifiable inability to wear intraoperative lead shielding and their proximity to the radiation source.…”

Section: Discussionmentioning

confidence: 99%

Computer-Assisted Instrument Navigation Versus Conventional C-Arm Fluoroscopy for Surgical Instrumentation: Accuracy, Radiation Time, and Radiation Exposure

Wang

Hamouda

Sankey

et al. 2019

American Journal of Roentgenology

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“…Particularly in the context of adolescent idiopathic scoliosis, extension of OTI to real-time segmental alignment tracking has the potential to significantly reduce radiation burden as well as time cost, major topics of ongoing investigation in the adolescent spine field. 57,58 Another feasible application of vertebral imaging using OTI involves the localization of levels for surgical site identification. The target level to be operated on is typically identified using some combination of intraoperative localization, using fluoroscopy or mobile XR, and preoperative placement of radio-opaque markers which are then captured on preoperative imaging.…”

Section: Future Directionsmentioning

confidence: 99%

Perspective review on applications of optics in spinal surgery

Guha

Yang

2018

J. Biomed. Opt.

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Optical technologies may be applied to multiple facets of spinal surgery from diagnostics to intraoperative image guidance to therapeutics. In diagnostics, the current standard remains cross-sectional static imaging. Optical surface scanning tools may have an important role; however, significant work is required to clearly correlate surface metrics to radiographic and clinically relevant spinal anatomy and alignment. In the realm of intraoperative image guidance, optical tracking is widely developed as the current standard of instrument tracking, however remains compromised by line-of-sight issues and more globally cumbersome registration workflows. Surface scanning registration tools are being refined to address concerns over workflow and learning curves, and allow real-time update of tissue deformation; however, the line-of-sight issues plaguing instrument tracking remain to be addressed. In therapeutics, optical applications exist in both visualization, in the form of endoscopes, and ablation, in the form of lasers. Further work is required to extend the feasibility of laser ablation to multiple tissues, including disc, bone, and tumor, in a safe and time-efficient manner. Finally, we postulate some of the short- and long-term opportunities for future growth of optical techniques in the context of spinal surgery. Particular emphasis is placed on intraoperative image guidance, the area of the authors' primary expertise.

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Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure

Cited by 78 publications

References 11 publications

A reliability and validity study for Scolioscan: a radiation-free scoliosis assessment system using 3D ultrasound imaging

A reliability and validity study for Scolioscan: a radiation-free scoliosis assessment system using 3D ultrasound imaging

Computer-Assisted Instrument Navigation Versus Conventional C-Arm Fluoroscopy for Surgical Instrumentation: Accuracy, Radiation Time, and Radiation Exposure

Perspective review on applications of optics in spinal surgery

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